The backdrop to the survey was that Swaziland has identified multiple sexual partners as a major risk factor in the transmission of HIV. Swaziland has the highest HIV infection rate in the world. In 2015 about 28% of people between the ages of 15 and 49 were HIV positive in Swaziland. The country has a population of 1.3 million people.

As a key strategy to manage the pandemic Swaziland’s Ministry of Health has prioritised policies to try and reduce the number of people who have multiple sexual partners – and particularly concurrent multiple partners. This has been identified as a key risk factor in the spread of HIV, particularly because studies show that heterosexual sex is responsible for 94% of new infections in the country.

The study focused on Facebook users because the uptake of social media has increased dramatically in the country with the arrival of low-cost mobile telephones. Studies conducted in the developed world have shown that online social networking technologies have been linked to increased risky sexual behaviour.

Our study looked at what kind of risky sexual behaviour is displayed by people who use social network sites. The hope is that the findings could inform policy.

Finding the right people

During the time the study was conducted, an estimated 63 720 people in Swaziland were using Facebook. This accounted for about 8.3% of the population aged 15 years and older.

Evaluating the trends in a statistically significant study needed a sample size of 2,000 people, so 2,000 participants were randomly selected and contacted through the social media site. Only Swazi citizens who were Facebook users, 18 years or older and had displayed their full surnames publicly on the social networking site were considered.

To develop a culturally sound questionnaire, focus group interviews were conducted on a range of topics. These included HIV and AIDS, people’s activities on Facebook, opinions and experiences of finding sexual partners on Facebook and general sexual behaviour.

This questionnaire included:

the number of sexual partners participants had had in the 12 months leading up to the study,

whether they had used a condom the last time they’d had sex,

whether they thought their steady partner had other sexual partners,

how much time they spent on Facebook each day,

their sexual experience with people they met on Facebook, and

whether they would use a health information Facebook page.

Study findings

Responses to the questionnaires showed that just over 80% of the men and women in the survey were sexually active. Over two-thirds were between 20 and 29 years old and were not married.

Many of the participants said they found it easier to initiate a romantic conversation on Facebook than face-to-face. As a result, they spent more time on Facebook.

A significant proportion of our study population admitted that they’d had sex with someone they had met on Facebook – and that they had had several partners at the same time.

For the purposes of the study, “meeting someone met on Facebook” was defined as meeting with someone that participants had spoken to on Facebook for the first time. This included people they knew as well as strangers. Studies have shown that up to a quarter of Facebook users accept friend requests from strangers.

The study identified important factors associated with multiple sexual partners, but did not delve into how people used Facebook to transform relationships into sexual ones.

Changing the landscape

The study also showed that Facebook has the potential to be used as a channel for health communication. Most of the participants with multiple sexual partners were willing to use a health communication Facebook page if it became available.

This suggests that policies to reduce the number of multiple sexual partners in the country could include these kinds of promotions.

As Facebook use among young people continues to expand people’s sexual networks are likely to increase. This potentially places young people at a high risk of HIV infection. HIV prevention programmes should, therefore, be designed with deliberate social media strategies.

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